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X OCTO- MONTH library at www . ausdoc . com . au / therapy-update
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2022
BER
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Initial assessment and education :
• blood glucose monitoring
• injection technique
• technology options
• NDSS registration
• dietitian consult
General Practitioner
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Weekly as required : continue education according to diabetes education plan that is responsive to person ’ s needs and management goals :
• lifestyle
• mental health
• complications and adjustments to therapy , including starting or changing technology and relevant NDSS registration update
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Education to prevent and manage complications |
Annual review :
• medical and social assessment
• education
• goal setting
Revise diabetes education plan for next year :
• responsive to needs and goals
• age specific educational requirements
• mental health assessment
• complications and screening
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Credentialled Diabetes Educator ( CDE )
Ongoing cycle of care / education
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Follow up phone call / email support and problem solving |
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Review sooner if :
• unresolved issues
• blood glucose or previous HbA1c above agreed targets .
• change in management i . e . change to medication / diet / exercise
• change in social situation that may impact management
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Diabetes Care Team members |
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• key life transitions
• symptoms of hypoglycaemia
• preparing for surgery
• sick day management
• drivers licence requirements
• pregnancy planning / contraception needs ( refer to pregnancy pathway )
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Family and / or Carers Primary Care Nurse Endocrinologist / Diabetes Physician Dietitian : medical nutrition therapy
Exercise Physiologist / Physiotherapist : tailored exercise program
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Podiatrist : comprehensive foot education and examination
Optometrist / Ophthalmologist : comprehensive eye examinations ( at least every 2 years )
Psychologist / Counsellor / Social Worker : mental health consultation
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Pharmacist : advice for taking medications
Interpreter
Aboriginal and Torres Strait Islander Health Worker / Practitioner / Elder
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RESOURCES
• Diabetologia 2021 ; 30 Sep . bit . ly / 3FC8c3w
• Med J Aust 2021 ; 15 Nov . bit . ly / 3YsfxLi
• Australian Diabetes Society consensus position statement on : utilising the ambulatory glucose profile combined with the glucose pattern summary to support clinical decision-making in diabetes care bit . ly / 3WhkG7k
• National Diabetes Services Scheme — Resource page bit . ly / 3HzLGur — Diabetes and driving booklet bit . ly / 3hmS25X
• Diabetes Australia : Blake ’ s story : Managing type 1 diabetes in a remote region bit . ly / 3Jc4hNi
• Aust Fam Physician 2015 ; Apr . bit . ly / 3W4RWPl
• Dose Adjustment For Normal Eating : Adults with type 1 bit . ly / 3HB2KAk
• Austroads and National Transport Commission : Assessing fitness to drive for commercial and private vehicle drivers ; 2022 edition . bit . ly / 3FRiXjI
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References Available on request from howtotreat @ adg . com . au |
1 . Which THREE statements regarding type 1 diabetes are correct ? a Ultimately , all people with type 1 diabetes will need insulin to maintain good health . b The onset of type 1 diabetes is more common in adults than in children . c Type 1 diabetes may initially appear to respond to oral glucose-lowering therapy . d The risks of insulin therapy include hypoglycaemia and weight loss .
2 . Which TWO statements regarding the epidemiology of type 1 diabetes are correct ? a The incidence of type 1 diabetes is modestly higher in women than in men . b The incidence of type 1 diabetes is increasing . c The incidence of type 1 diabetes is higher in predominantly Asian countries . d In Australia , more than 150,000 adults have type 1 diabetes .
3 . Which THREE factors are thought to contribute to the pathogenesis of type 1 diabetes ? a Immunisation . b Progressive autoimmune destruction of the insulin-producing β-cells of the endocrine
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pancreas . c Genetic susceptibility . d A ‘ trigger event ’ that establishes an autoreactive process in susceptible individuals .
4 . Which THREE , coupled with symptoms , indicate a diagnosis of diabetes ? a A fasting venous blood glucose concentration of 7.0mmol / L or greater . b A random blood glucose level of 11.1mmol / L or greater . c The detection of glucose in the urine . d An HbA1c of 6.5 % ( 48mmol / mol ) or greater .
5 . Which ONE statement regarding diagnosing type 1 diabetes in adults is correct ? a All adults with type 1 diabetes have islet antibodies . b Negative islet antibodies excludes a diagnosis of type 1 diabetes . c A C-peptide level of less than 200pmol / L is consistent with a diagnosis of type 1 diabetes .
d All patients with type 1 diabetes have low C-peptide levels at diagnosis .
6 . Which TWO statements regarding insulin in type 1 diabetes are correct ? a The total daily insulin requirement for an adult with type 1 diabetes is usually between 0.3 units / kg and 0.4 units / kg . b Insulin therapy should be carefully individualised , culturally appropriate and titrated , accompanied by appropriate patient education , training and support . c The basal component makes up about 60 % of the total daily insulin dose and the bolus component about 40 %. d The usual insulin regimens include either a multiple daily injection ( basal – bolus ) regimen or a continuous subcutaneous insulin infusion ( insulin pump ).
7 . Which ONE is the most common cause of hospitalisation in adults with type 1 diabetes ? a Severe hyperglycaemia .
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b Hypoglycaemia . c Foot ulcer . d Diabetic ketoacidosis .
8 . Which ONE is an appropriate target for first morning and premeal blood glucose ? a 5-9mmol / L . b 4-7mmol / L . c Less than 53mmol / mol . d 48mmol / mol .
9 . Which THREE statements regarding type 1 diabetes are correct ? a Encourage a healthy diet and lifestyle , with limited alcohol and no smoking . b Recommended blood glucose concentration before and during driving is greater than 5mmol / L . c Target blood pressure of less than 140 / 90mmHg . d Oral glucose-lowering agents are useful adjuvants in adults with type 1 diabetes .
10 . Which THREE increase the risk of hypoglycaemia in type 1 diabetes ? a Excessive physical activity . b Excessive intake of refined sugars . c Excessive alcohol consumption . d Excessive doses or incorrect administration of insulin .
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